5 things students overlook when choosing a specialty

Whether you’re a first or fourth year medical student, choosing your preferred specialty is a major decision, but how do you determine what to practice? Learn how to choose a specialty with tips from an advisor who understands your mindset.

Surendra Varma, MD, has worked as the executive associate dean for graduate medical education and resident affairs at Texas Tech University since 2007. Each year, he advises 40 to 50 medical students about their residency program applications.

When it comes to specialty choice, Dr. Varma said he’s noticed an interesting trend: Most students want to choose a specialty they genuinely enjoy, but often lack exposure to a variety of disciplines to make an informed decision.

“Unless they have a parent who’s a physician or they attended some kind of medical service trip, the majority of students entering school aren’t exposed to many specialties outside of the popular ones like pediatrics or primary care,” he said.

The Association of American Medical Colleges (AAMC) 2015 Report on Residents found 56 percent of medical students change their preferred residency specialty over the course of medical school. This data is based on comparisons between the specialties students selected on the AAMC’s Matriculating Student Questionnaire, which students are invited to complete during the summer before their first year of medical school, and the specialties they later chose on the AAMC Graduation Questionnaire during their final year of medical school.

Dr. Varma said he understands why students often change specialties between each questionnaire, noting that it may be more productive for students to initially select their specialties after they matriculate and gain exposure to their options.

So how can you learn more about specialties and find the best fit for you? Make sure you don’t overlook these important factors when determining what to practice:

Assess your skills—not just the amount of money you wish to make

While the lifestyle and revenue associated with a particular specialty are important, students should also consider the skills required for the field. Avoid pursing a practice simply because of its prestige or earning power.

For instance, “many people want to go into orthopedics or surgery, but what if you don’t have the skills to successfully perform a surgery?” Dr. Varma asked, noting that Texas Tech University offers a simulation center for students who wish to test their skills in a medical setting.

Find out if your school provides similar resources, so you can take inventory of your strengths and weaknesses and choose a specialty that truly fits your talents.

Gain clinical experience in your preferred specialty

Shadow an attending physician in your field as much as you can. “The best way to do this is through an externship,” Dr. Varma said.

However, if you can’t work one into your schedule, join specialty clubs at your school and take advantage of free talks and lectures to gain exposure to different disciplines. “Most schools have a club for every specialty and people do more than just have lunch,” Dr. Varma said. “Physicians will come to club meetings and talk about their work and the lifestyle of their practice.”

Research the culture and availability of your specialty

The popularity of specialties can shift based on each generation of medical students, which will impact job availability.

Data from the AAMC suggests that factors like gender may also impact specialty choice, so take the time to consult practicing physicians and advisors about the culture of different disciplines. This will help you develop a holistic view of the practice environment you may work in.

Choose a backup specialty

This one is hard for many students to accept, but it’s important, Dr. Varma said. While gaining exposure to your preferred specialty, it’s helpful to also identify a backup specialty you’d be happy practicing, especially if your primary choice is in a competitive field.

“We usually tell students to apply to 20 or 25 programs and use interviews to gauge whether or not they’ll match in a certain specialty,” he said. “In competitive fields like orthopedic surgery and urology, students may even want to apply to 40 or 50 programs.”

Make your residency program application as authentic as possible

It’s counterproductive to research a specialty that uniquely fits you, only to submit an application that sounds similar to your colleagues.

Also, don’t forget: The personal statement is a chance to show who you really are and why you’re the best fit for a specialty. “Please, don’t submit a cookie cutter essay about why you want to work in surgery,” he said. “Go from the heart.”

Comments

I'm interested as to how you advise someone as to whether he or she has the technical skills to become a surgeon. As a third year concerned about this, I've talked to a dozen surgeons who have all told me that the vast majority of surgeons didn't all have some raw natural talented hands that told them they should be in the field, and that they really can't tell who will be have superior skills in the end. The vast majority simply decided to get surgical training and to work hard. Certainly you have to be on some bell curve, but the tail is small. Gawande echoes this in his books as well.

There is no question that a subset of medical students have what surgeons call "bad hands " which is really a disconnect to a variable extent centrally to peripherally. 2 recent residents could not correct this lack of progress in the operating room environment. A switch to a non procedural specialty led to a very successful and happy non procedural residency with the change - and with lowered stress levels. I know of no study with #'s but I estimate ~20 % have the deficit. Even most of those improve and "make it" but not without some smoothness. 20% are naturally with "good hands. Those are easy to spot early on as a medical student in the clinical rotation years.